心衰生物标记物研究新进展

心力衰竭(心衰)是临床最常见的危重疾病之一,其致死率不低于某些癌症。随着现代医学进展,年龄依赖性死亡率明显下降,冠脉事件显著减少,患者生存时间延长,心衰患病率较前增加。针对心衰的研究不断更新,心衰的病理生理机制日益趋向完善,不仅仅涉及先前众所周知的心肌损伤或者心脏前后负荷增加,更多因素先后被发现参与心衰的发生、发展,包括神经内分泌机制、炎症反应,内分泌信号系统和生化因素等。伴随心衰病理生理过程产生了一系列的生物标记物,某些生物标记物在协助临床医生诊疗心衰患者方面发挥重要作用。具体包括神经激素类生物(例如:脑钠肽、氨基末端-pro BNP、心房钠尿肽前体中段、肾上腺髓质素前体中段和嗜铬素A),炎症因子类生物标记物(例如:CRP、IL-6和ST2),内分泌生物标志物(例如:脂联素、抵抗素、瘦素和醛固酮),其他生物标记物(包括:肌钙蛋白I/T、乳糖凝集素-3、胱氨酸蛋白酶抑制剂C、生长分化因子-15和基质金属蛋白酶)。生物标记物凭借其高度敏感性及特异性,在心衰的诊断、危险分层及评估预后等方面发挥重要作用。本文就心衰生物标记物最新研究进展做一综述。     

蚯蚓生物标记物在土壤生态风险评价中的应用

蚯蚓在土壤中行使了很多重要的生态功能,蚯蚓生物标记物常用作土壤污染风险评价研究。这篇综述的目的是探讨当前蚯蚓生物标记物研究是否可以应用到实际的土壤污染风险评价。1)讨论了蚯蚓生物标记物在土壤污染风险评价体系中的重要性,认为它是化学分析方法的有益补充,可以提供更为全面和客观的土壤污染信息;2)综述了相关研究中所使用的蚯蚓类型,土壤类型和生物标记物类型,及其它试验设计要素和最后结果的变异,认为目前蚯蚓生物标记物研究以实验室基础研究为主,筛选出了大量的生物标记物,一定程度上揭示了生物标记物的对各类典型污染物及其组合的应答机制;同时也认为,未来的蚯蚓生物标记物研究应该重点探讨将其应用到实际的土壤污染风险评价中的可行性及如何应用;3)目前不同研究之间从试验设计到结果都具有很大的变异,难以通过综合比较获得完全可靠的具有实践意义的结论和成果,因此,有必要通过建立标准化的蚯蚓生物标记物研究方法,推动生物标记物的研究工作;4)提出了蚯蚓生物标记物研究方法标准化的具体建议,推荐了蚯蚓生物标记物走向实际应用所需要解决的问题。     

慢性心力衰竭相关生物学评价指标的研究进展

随着我国人口老年化进程的日益加快,老年慢性病的发病率呈走高态势。慢性心力衰竭(chronic heart failure, CHF)作为心血管系统常见的一种疾病,仍是老年人最主要的死亡原因之一。虽然医疗技术在不断提高,但目前CHF的诊治仍存在一定的问题,因此迫切需要寻求新的诊断、分层及预后的评价指标。由此,本文将对近年来CHF的相关新的生物标记物予以综述,为后期新指标的探索提供参考。     

建立生物标记物束

各组跟踪时间轨迹的生物标记物可以帮助破解疾病,需要多种途径来鉴定和验证新的标记物。     

多发性硬化生物标记物的研究进展

多发性硬化(MS)是主要以中枢神经系统(CNS)白质脱髓鞘病变为主要特点的自身免疫性疾病。生物标记物是中枢神经系统自身免疫性疾病病因、诊断和预后的重要参考因素,因为他们可能反映遗传以及环境变化所引起的某些免疫反应的存在,性质和强度。因此生物标记有助于MS的早期诊断和鉴别诊断,指导治疗方案,推断MS疾病活动性,以及判断疗效。本文概述了多发性硬化领域当前的生物标记物研究状况及其相关的临床实践,并通过对三种具有较大潜力的生物标记物与病理的特异性、灵敏度、可靠性和临床实用工具进行分析,以确定最优化的治疗以防止致残,同时还可以对疾病修饰药物的有效性进行测试。     

在医疗保健领域开发和使用生物标记物的政策性问题

描述了发展中的生物标记物所处的科学、产业、监管和医疗保健管理系统背景,指出了可能阻碍生物标记物研究、发现、发展、商业化及最终临床应用的一些障碍,聚焦了医疗保健中基于生物标记物的诊断方法和医学检验的应用,探索了生物标记物在改良药物开发中的应用。     

网膜素在神经关联疾病中的生物标记物作用

网膜素(omentin)是一种新型的脂肪因子,由内脏脂肪组织分泌。研究发现,网膜素在脑梗死、成神经细胞瘤、多发性硬化等神经关联疾病中发挥着重要作用,并与疾病的发生、发展具有良好相关性。因此,网膜素或可成为神经关联疾病的生物标记物,为相关疾病的诊断、治疗和预后评估提供新指标。     

急性肺损伤的生物标记物

急性呼吸窘迫综合征(ARDS)和急性肺损伤(ALI)多由低氧性呼吸衰竭引起,导致高通透性肺水肿,临床上有较高的发病率与死亡率。近十年来,针对血浆和支气管肺泡灌洗液中相关生物标记物的研究为探索急性肺损伤的病理生理机制指明了新的方向。个别生物标记物已在一些大型、多中心ARDS试验中得到证实。但迄今仍没有一个或一组生物标记物常规应用于临床。随着人类对ALI发病机制理解的进一步深入,或许不久的将来,生物标记物会真正应用于评估疾病的严重程度和预后。本文将概述近年来ALI相关生物标记物的研究进展。     

交联法在分子生物学研究中的应用

本文概要介绍了交联法用于阐明染色质、核小体、病毒粒子、核糖体结构、观察HS70基因-组蛋白等七种核酸-蛋白质复合物中大分子相互作用的实例;列举了它在DNA构象、RNA立体结构及mRNA、tRNA、snRNA、hnRNA、rRNA间相互作用等研宄中的应用。从文中可以看出,交联法的应用范围遍及遗传信息储存的高级结构、转录体系及调控、翻译系统及调控等分子生物学研究的几个主要侧面。     

Bioindicators Versus Biomarkers in Ecological Risk Assessment

The biomarker approach, adopted from medical toxicology, is subject to several theoretical and practical difficulties when used to address environmental problems. The problems are related to the definition that emphasizes measurement but does not specify a requirement to establish cause-effect linkages. An improved definition for a bioindicator is reviewed. The sentinel species approach is judged to be a biomarker rather than a bioindicator, and therefore of limited use for environmental risk assessment. An empirical weight of evidence approach to improve the utility of sentinel species is proposed.     

国内外心力衰竭治疗质量评价的研究现状

心力衰竭是世界主要的公共卫生问题之一,庞大的心力衰竭患者消耗着大量的医疗资源。近几十年,世界各国专家越来越关注心力衰竭的治疗质量,评价治疗质量已成为医疗体制改革的一项措施。通过总结国内外心力衰竭治疗质量评价的组织机构、评价指标、治疗质量改善项目及有关评价研究,探讨我国心力衰竭治疗质量评价与国外的差距,针对出现的问题,提出相应的建议,为改善我国心力衰竭的治疗质量提供新思路。     

Approaches for Integrated Risk Assessment

Recognizing the need to enhance the effectiveness and efficiency of risk assessments globally, the World Health Organization's International Programme on Chemical Safety, the U.S. Environmental Protection Agency, the European Commission, and the Organization for Economic Cooperation and Development developed a collaborative partnership to foster integration of assessment approaches used to evaluate human health and ecological risks. The objectives of this effort included: improving understanding of the benefits of integration, identifying obstacles to the integration process, and engaging key agencies, organizations, and scientific societies to promote integration. A framework with supporting documentation was developed to describe an approach for integration. Four case studies were constructed to illustrate how integrated risk assessments might be conducted for chemical and nonchemical stressors. The concepts and approaches developed in the project were evaluated in an international workshop. The goal of this effort was international acceptance of guidance for integrated risk assessment.     

Assessment of Global Coronary Heart Disease Risk in Overweight and Obese African‐American Women

Objective : To examine, with the use of national guidelines, coronary heart disease (CHD) risk with increasing BMI for primary prevention in urban African‐American women. Research Methods and Procedures : Participants were recruited for CHD risk factor screening from 20 churches as part of a larger study of nutrition and fitness (Project Joy). All participants had a demographic, smoking and medical history assessment, and the following measurements were taken: weight, height, waist circumference, blood pressure, lipid levels, and glucose. Three methods of defining risk, the Framingham Point Scoring System, a count of risk factors, and the presence of the multiple metabolic syndrome, based on the National Cholesterol Education Program Adult Treatment Panel III Report and BMI classes established by the Clinical Guidelines, were used. Results : A total of 396 women were eligible. Participants were 40 to 80 years of age and had marked excess prevalence of overweight and obesity (84%); 55% were obese. There was a linear increase in risk factors as BMI increased. Lipids did not differ significantly among BMI classifications. Seventeen percent of women had multiple metabolic syndrome. Eight percent and 16% of women in the normal and overweight BMI classes, respectively, had two or more modifiable risk factors. There was no difference in number of modifiable risk factors among the obese classes. The Framingham Point Scoring System assigned a <10% risk of a hard CHD event in 10 years to 97% of the women. Discussion : National risk assessment guidelines for primary prevention of CHD may not be adequate for overweight and obese urban African‐American women and require further study.     

The Food Web Approach in Ecotoxicological Risk Assessment

The Standing Committee on Ecotoxicology of the Health Council of the Netherlands (see note at the end of this article) has reported on the potential and limitations associated with the use of food web models in ecotoxicological risk assessment. This paper closely follows the executive summary of that report. The current appoach in ecotoxicological risk assessment is based on single species toxicity tests. It is felt that the food web approach, which takes feeding relationships between species in ecosystems into account, provides an opportunity to address effects of toxic substances on the ecosystem level. It is considered to be particularly useful in site-specific risk assessment concerning specific (types of) ecosystems. However, supplementary research must be carried out before food web models can be used in ecotoxicological risk assessment.     

循证医学在慢性充血性心力衰竭药物治疗中的应用

循证医学(evidence-based medicine,EBM)是近年来国际临床医学领域迅速发展起来的新学科,强调"为每位病人作出医疗决定时,应明确而仔细地使用现有的最好证据"。本文利用循证医学的方法,参照若干著名的大规模多中心的随机对照试验(ran- domized controlled trial,RCT)来评估目前几类临床常用药物在治疗慢性充血性心力衰竭中的作用,试图找出针对不同NYHA等级患者的最佳治疗建议。     

卡维地洛联合厄贝沙坦治疗慢性心功能不全的疗效及对IL-6的影响

目的:探讨卡维地洛联合厄贝沙坦治疗慢性心功能不全的疗效及对血浆IL-6的影响。方法:选择64例慢性心功能不全患者采用平行对照法随机分为治疗组和对照组各32例,对照组给予血管扩张剂、利尿剂和强心剂等基础用药进行常规治疗,观察组在对照组的基础上加用卡维地洛联合厄贝沙坦进行治疗,疗程均为4周,观察两组患者的临床疗效、心功能分级和血浆IL-6水平变化情况。结果:4周疗程后,观察组总有效率为84.38%显著高于对照组的59.38%,差异有统计学意义(P0.05);心功能分级变化情况显示,治疗后两组患者心功能分级状况都有所变化,症状得到改善。与对照组相比观察组I级患者数量明显增加,III级数量减少,差异有统计学意义(P0.05);治疗后两组患者IL-6水平均下降,且左室射血分数(LVEF)值升高,与对照组相比观察组患者指标水平变化明显,差异有统计学意义(P0.05)。结论:在常规用药基础上加用卡维地洛和厄贝沙坦,可改善慢性心功能不全症状,降低IL-6水平,临床疗效显著。     

Application of an Ecological Risk Assessment for Evaluation of Alternatives Considered for Restoration of Oysters in Chesapeake Bay: Background and Approach

Oyster populations in Chesapeake Bay, USA, declined precipitously over the past three decades, and on-going efforts to restore the native oysters to former abundance were considered to be ineffective. Maryland and Virginia natural resource agencies proposed the introduction of a non-native Asian oyster (Crassostrea ariakensis) that is resistant to diseases affecting the native oyster and well adapted to the Chesapeake Bay environment. Numerous stakeholders raised concerns about potential adverse consequences of an introduction of a non-native species into a new environment. In response, state and federal agencies determined that an Environmental Impact Statement (EIS) should be prepared to address the environmental consequences of such an introduction as well as of seven other oyster restoration alternatives, including several involving only the native oyster. Preparation of an Ecological Risk Assessment (ERA) of the proposed action as well as all alternatives was an integral element of EIS preparation. This series of articles describes several different analyses that contributed to and collectively comprised the ERA conducted as input to the EIS. The final article of this series in HERA describes how the ERA and EIS findings were taken into account in the final decision on the preferred restoration alternative by state and federal agencies.     

A Risk Assessment Approach for Policy Evaluation: New Jersey Case Studies

Monitoring environmental policy progress often focuses on contaminant concentrations while policy goals address health. To bridge this gap, we developed policy evaluation case studies applying risk assessment methods to explore population health risks of chemical exposures before and after policy implementation. Beginning in the 1970s the New Jersey Department of Environmental Protection provided some of the United States' first data on contaminants including trichloroethylene in drinking water and polychlorinated biphenyls (PCBs) in fish. These data provide a unique opportunity to evaluate environmental policies. The 1979 PCB manufacturing ban succeeded in reducing exposure and risk, but the persistence of these compounds in local fish requires continued state and local consumption advisories. The positive impact of drinking water standards for trichloroethylene was reflected in declining detection in public water supplies from the late 1970s to 2005, although maximum concentrations in a small percentage of supplies remain above standards. Our case studies show success and progress, and the need for multiple policies in combination when conditions warrant. Tracking specific policies and contaminants using risk assessment methods can be a valuable tool for policy evaluation and can foster population-based environmental health research. Pollution prevention policies are warranted for chemicals that persist in the environment.     

Machinery Risk Assessment for Risk Reduction

New avenues are reviewed and discussed for preventing industrial machine-related injury by means of realistic risk evaluation and reduction processes at the design and application stages of machinery development and use. U.S. guidelines and European standards on machinery risk assessment procedures are described. Applications of risk assessment for machine-related injury risk management and teaching machine-risk control are discussed.